Using the Innovations Exchange to Develop Health Professional Competencies

1. Using the Innovations Exchange to Develop Health Professional Competencies Web Seminar September 18, 2013 Follow this event on Twitter Hashtag: @AHRQIX

2. Using the Webcast Console and Submitting Questions To submit a question, type question here and hit submit. Click the Q&A widget to get the Q&A box to appear 2

3. Accessing Presentations Download slides from console Click on the “Download Slides” button for a PDF version 3

4. What is the Health CareInnovations Exchange? Publicly accessible, searchable database of health policy and service delivery innovations Searchable QualityTools Successes and attempts Innovators’ stories and lessons learned Expert commentaries Learning and networking opportunities New content posted to the Web site every two weeks Sign up at http://www.innovations.ahrq.gov under “Stay Connected” 4

5. Innovations Exchange Web Event Series Archived Event Materials Available within two weeks under Events & Podcasts http://www.innovations.ahrq.gov Examples of Past Events May 9, 2013 A Close Look at Care Coordination within Patient-Centered Medical Homes April 9, 2013 Promoting the Spread of Health Care Innovations 5

6. Presenter Kathleen Stevens, RN, EdD, FAAN Professor and Director Academic Center for Evidence-Based Practice Improvement Science Research Network University of Texas Health Science Center San Antonio 6

7. Catalysts for Innovation Improving your work is our work • Improvement requires change • Not all change lead to improvement Test innovations…Plan, Do, Study, Act (PDSA) 7

8. Catalysts for Innovation • Recommendations and Initiatives • New Curricula Guidelines 8

9. Catalysts for Innovation Patient Protection and Affordable Care Act: Title V Health Care Workforce “…to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations by… • enhancing health care workforce education and training… • providing support to the existing health care workforce …” 9

10. Discovery Research Evidence Summary Process, Outcome Evaluation Translation to Guidelines Practice Integration Academic Center for Evidence-based Practice (ACE) Star Model of Knowledge Transformation 10

11. Evidence Synthesis AHRQ Health Care Innovations Exchange 1 2 5 USPSTF 4 3

12. Is Innovation Difficult? Watermelon Squared 12

13. What They Did; Did It Work? • Every title includes the innovation and the outcomes • Example 1: Patient- and Family-Activated Response Team • Averts Potential Problems and Generates High Levels of Patient, Family, and Staff Satisfaction 13

14. What They Did; Did It Work? • Every title includes the innovation and the outcomes • Example 2: Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners • Results in Better Outcomes and Fewer Emergency Department Visits for Low-Income Seniors 14

15. http://www.innovations.ahrq.gov/content.aspx?id=2668 15

16. http://www.innovations.ahrq.gov/content.aspx?id=2668 16

17. Problem Addressed • Intensive care unit patients have life-threatening problems and complex care needs • Require a combination of many treatments and services to achieve timely recovery and discharge • Susceptible to preventable complications (i.e. ventilator-associated pneumonia, deep vein thrombosis, and catheter-associated bloodstream infections), which lead to suboptimal clinical outcomes and prolonged length of stay • Tools to improve communication and checklists to guide adherence to evidence-based interventions are known to improve outcomes, yet many hospitals have not adopted these initiatives 17

18. What They Did • Created an improvement team • Established multiple initiatives designed to improve care including a comprehensive unit-based safety program (CUSP) to enhance the culture of patient safety and tools to expedite the translation of evidence into practice • Used evidence-based processes to reduce catheter-related bloodstream infections • Integrated proven interventions to reduce complications associated with mechanical ventilation • Adopted tools and tactics 18

19. Did It Work? • Improved the culture of safety among participating ICUs • Prevented catheter-associated bloodstream infections • 1,800 lives saved • 140,000 hospital days avoided • $270 million in savings in 5 years • Evidence rating: moderate • Pre- and post-implementation comparisons of safety culture survey results and catheter-related bloodstream infections • Predictive model that estimated the number of lives, dollars, and hospital days saved over a 5-year period 19

20. http://www.innovations.ahrq.gov/content.aspx?id=2685 20

21. http://www.innovations.ahrq.gov/content.aspx?id=2812 21

22. What They Did • Assessed the causes of the patient's poor blood pressure control • Developed a guideline-based treatment plan • Monitored patients’ treatment response at regular intervals • Made recommendations as necessary to the treating physician for medication adjustments designed to achieve good blood pressure control 22

23. Did It Work? • Improved blood pressure control, even in hard-to-treat patients with diabetes • Increased physician adherence to established treatment guidelines for hypertension • Evidence rating: strong • Prospective, cluster randomized controlled trial at six community-based family medicine residency programs • Measured pre- and post-implementation blood pressure levels, degree of adherence to established treatment guidelines, and self-reported patient adherence to the prescribed regimen 23

24. Will It Work Here? A Decisionmaker’s Guide to Adopting Innovations • Does this innovation fit? • Should we do it here? • Can we do it here? • How can we do it here? Taking Innovations to Scale • Resources to assist innovators and adopters • Spread success stories • Presentations and reports 24

25. Innovation is the one competence needed in the future… --Peter Drucker …early adoption is the second --Kathleen Stevens 25

26. Presenter Judith Kunisch, BSN, MBA Lecturer Yale School of Nursing Yale University 26

27. Using the Innovations Exchange as an Effective Practical Teaching Tool: A Case Study 27

28. Background and Goal • Health care professional study includes course work related to quality and safety and the business of healthcare • Innovations Exchange provides teaching opportunities for all levels of study • Nursing undergraduates • Masters level – MSN, MBA, MPA, MPH • Doctoral level – DNP • Learning activities/assignments vary with the level of study and focus of the course 28

29. Examples of Learning Activities • Quality and safety: nursing undergraduates, masters level • Innovation business plans: masters and doctoral level 29

30. Masters Example: Leadership Practice • Advanced practice students • Semester course; 100 students • Practice competency in leadership/quality and safety • American Association of Colleges of Nursing (AACN) Masters Essentials • Quality and Safety Education for Nurses 30

31. Masters Example (continued) • Two part assignment: presentation, written memo • Innovations Exchange provides “contexts of care” • Innovation adoption guide • Profiles and quality tools organized by subject areas

32. The Assignment: Presentation • Working in pairs • Small group presentation (leadership communication) • Single PowerPoint slide, 5-7 minute presentation, 5 minute question and answer • Single slide tells a visual story; useful in other settings 32

33. The Assignment: Written Memo • 5-6 paragraph written memo to senior leader • Practice writing (leadership communication) • Translate the components of patient safety and risk management to a current topic in quality improvement • Comment on the value of the innovation or tool • Incorporate other relevant articles and references

34. Active “Hands On” Learning • Student centered: learn to use the site, evaluate and analyze innovations/tools • Result: students will not forget the Innovations Exchange; updated and reliable • Without the assignment, teaching options include: • Show them: passive learning, no motivation to use it • Tell them: passive learning, no motivation to look at it • “Wait until I am in practice and need to use it” or“Maybe I will do this someday” 34

35. Example: Student Slide 35

36. Measurable Objectives • Students understand AHRQ selection criteria for innovations and quality tools • Each innovation or quality tool selection is relevant to student’s area of interest and practice • Student employs critical analysis of a specific innovation or tool • Students practice professional communication with a presentation and written memo 36

37. Example: Student Slide 37

38. Example: Student Slide 38

39. Example: Student Slide 39

40. Example Student Memos:Selected Phrases • “As an advanced practice nursing student of family psychiatry, I am particularly interested in interventions that aim to address the gaps in systems of care for youth with mental health illnesses ….” • “… strength of this intervention is the emphasis on care coordination to bridge the experience from treatment discharge to community reentry….” • “…. a tool with comprehensive information is important for treating every patient, but it is particularly important in Pediatrics …” • “If I was going to change anything at all, I would expand it to be a global pediatric cancer tool because it is so helpful….” • “Thank you for your time and for your dedication to quality improvement in healthcare.” 40

41. Grading Criteria Presentation • Slide is easy to read; accompanies the oral presentation • Not graded on public speaking ability – this is practice! Memorandum • Set up professionally • Student opinion is reasonable and relevant to practice • Overall writing demonstrates an understanding of the innovation or tool and its relationship to practice • Student compares it with other tools or innovations he/she has observed or used in practice 41

42. Questions? Click me to get Q&A box to appear 42

43. The Innovations Exchange • More information on Yale’s School of Nursing assignment: http://innovations.ahrq.gov/resources/student/syllabus.aspx • Visit our AHRQ Health Care Innovations Exchange: http://www.innovations.ahrq.gov/ • Follow us on Twitter: @AHRQIX • Send us email: info@innovations.ahrq.gov 43